Discussion on the law that applies to or affects Australia's emergency services and emergency management, by Michael Eburn, PhD and Barrister.

New law for ambulance services in Tasmania – Update

In my post of 29 August I talked about the definition of ‘paramedic’ in the Ambulance Service Amendment Bill 2013 (Tas). In response to some questions posed I’ve gone back to that section and realise I made a pretty significant mistake in my interpretation, most importantly I missed the words in the introductory part that says “For the purposes of this Act, a person is a paramedic if the person is – (a) an officer of the Ambulance Service who…”

I now revisit the issue of who will be a paramedic in Tasmania with the passage of this Bill. The relevant section says, in full:

For the purposes of this Act, a person is a paramedic if the person is –
(a) an officer of the Ambulance Service who –
(i) holds –
(A) a prescribed paramedic qualification; or
(B) a qualification and experience that the Commissioner is satisfied demonstrates a satisfactory level of understanding and competence in the areas of knowledge contained within a qualification prescribed under sub-subparagraph (A); and
(ii) is appointed to a position determined by the Commissioner to be a paramedic position; or
(b) an officer of a prescribed ambulance service of another jurisdiction who –
(i) is an officer of the ambulance service in that jurisdiction; and
(ii) holds the prescribed paramedic qualification, or a qualification and experience, referred to in paragraph (a)(i); and
(iii) is approved by the Commissioner as suitably qualified to provide clinical care; and
(iv) is providing clinical care in accordance with any protocols specified in the approval given by the Commissioner under subparagraph (iii); or
(c) a prescribed person, or a member of a prescribed class of persons, who meets any requirements, conditions or approvals prescribed in respect of that person or class of persons.

To be a paramedic you must fit either (a), (b) or (c).

Paragraph (a) is restricted to officers of the ambulance service. They must either hold a prescribed qualification (presumably a relevant university degree) or such other training and experience that the commissioner approves (allowing for those trained ‘in house) AND be appointed to a position that the Commissioner has determined is a paramedic position. Critically this paragraph refers or is limited to ‘an officer of the Ambulance Service…’ A person who is not employed by the Ambulance Service cannot call themselves a paramedic if they cease to be an ‘officer of the Ambulance Service’. What that would mean for Ambulance officers who are working for a NEPT provider, or St John Ambulance in their off duty hours is unclear.

Paragraph (b) is limited to paramedics from another jurisdiction operating in Tasmania, so this would facilitate interstate assistance.

Paragraph (c) is a catch all that allows regulations to list others so people who want to practice as a paramedic outside Ambulance Tasmania would need to persuade the Department and Minister to list their qualifications, position etc. In the absence of a regulation expanding the definition to private providers, it does appear that the term ‘paramedic’ in Tasmania will be restricted to employees of Ambulance Tasmania and inter-state ambulance services.

2 thoughts on “New law for ambulance services in Tasmania – Update”

In Paramedics Australasia’s submission to the Tasmanian Government when the review of the act was announced, they said: “PA considers it important that the legislation not restrict, for example through the restrictions on use of titles, the work of paramedics in legitimate settings outside ambulance services.”

The submission also said: “It would be important that the legislation not restrict the use of specified titles in Tasmania to those working in ambulance services since it is clear that there are a number of other types of employment where paramedics may legitimately work and need to use the title. For example paramedics work in the University of Tasmania, with training providers and private sector health service providers, as well as at public events and industrial sites.”

So supposing that this submission was considered and followed, I would assume that provided the paramedic is employed by Ambulance Tasmania, they are entitled to use the term “Paramedic” elsewhere, for example when volunteering for St John Ambulance. There doesn’t seem to be anything specifically stated in the amendments that would prevent this (such as saying that a person is only a paramedic whilst representing the ambulance service, only that they are an officer of the ambulance service).

I’m not sure how this will work in reality though. I would have thought that since any other Health Care Professional regulated through AHPRA requires Indemnity insurance, paramedics would require something similar, even though they are not regulated. I guess that’s an entirely different legal question.

David Watson, the owner of Ambulance Private, a private ambulance company in Tasmania (see http://ambulanceprivate.com.au/) posted a comment on the Ambulance Service Amendment Bill 2013 (Tas). I do not intend my blog to be a forum for private interests to advance their case, but, equally, just because he has a commercial interest does not mean that David’s comments are without merit or cannot provide a useful insight into the implications of the Bill.

With David’s permission, what appears below is an edited version of his original post. It should not be assumed that I either agree, or disagree, with any of the conclusions here. I’m posting these comments in the interest of open discussion and because I’m sure the comments will be of interest to readers of this blog. I’d welcome further comments on the operation of the Bill and private ambulance services both in Tasmania and elsewhere.
Michael Eburn.

Written by:
David Watson
Owner, Ambulance Private

Ambulance Private is clearly the largest operator and also the trailblazer, commencing operations in mid-1998. It operates nearly 20 ambulances around Tasmania. I believe my background of 25 years with the Tasmanian Ambulance Service, and a further 15 years with Ambulance Private enable me to capably analyse the proposed legislation.
I stand against sections of this legislation for the following reasons:
• It has a dramatic increase in red tape, in regulation and in compliance;
• It will seriously increase cost of service for Tasmanians as fees and compliance are passed on;
• It financially penalises existing operators in the private ambulance sector;
• And it has more to do with the current government service repositioning itself in Tasmania than it has to do with regulating the already regulated private ambulance operators.

(Red Tape etc)
Each of the four private ambulance operators in Tasmania is subject to the terms and conditions of a Consent, issued by DHHS. Whilst some may argue it is not a perfect document, it provides direction, standards and conditions to be adhered to. Failure to follow it will lead to withdrawal of the Consent, in other words closure of the business. It is capable of being amended at any time with mutual agreement. There is a strong implication from supporting documents the private ambulance industry is currently unregulated, yet this is simply not true. I suggest reviewing a copy of the Consent would assist MLC’s in understanding the issue.

(Cost of Service…)
It is claimed within the various documents that “minimal costs” will be added to the private sector operators, however this is not correct. The only “minimal cost” will be the collection of renewal fees, earning the government a staggering $2000 in total per annum from the entire private ambulance industry! The real costs facing private ambulance operators include doubling Public Liability Insurance at $6-7000, internal compliance and meeting costs, re-badging ambulances at as much as $1200 per vehicle, twin stretcher ambulances instead of the current single stretcher, with additional stretchers about $7000. The list goes on with additional vehicle registration costs, removal of warning devices and a very serious concern of a drop in revenue with the removal of ability to operate as a private ambulance service.

(Penalises existing operators)
It has been stated the proposed legislation is a “minor revision” of the private ambulance sector. It is not. It is a massive revamp. It is claimed “major health benefits” will be gained but this is also not true. It is claimed that “road users are at risk” of private ambulances using warning devices. Again this is simply not true.
This proposed legislation attacks the very basis of the private sector. Against formidable odds the first licence was given out and has survived for 15 years. Others have entered more recently but the overall size of the government ambulance service has been restrained by not having to handle the private sector caseload. This is not in the emergency area, as the private ambulance industry does not offer that role. It is in the non-urgent or routine area where the impact has been felt. Once again, I say if the private ambulance sector left the State, we would require as many as 20 additional ambulances, with as much as 60 staff to operate them round the clock. We have them in the State now, at usage cost only. Why are we addressing legislation which will increase private sector costs and will decrease private sector caseload?

It is worth looking at the investment made in Tasmania by the private sector. An equipped ambulance as used by us averages at $100,000. Ambulance Private has upwards of 20 units! This is a significant investment in Tasmania and deserves support and encouragement, not dangerous restructuring conducted without any serious consultation!

(Current government service repositioning)
We are told the Economic Reform Unit has advised DHHS that, in principle, the proposals will impose a restriction on competition of a minor nature. If this is correct the Unit has dramatically understated the impact of change on the private sector. Its comment is absolutely incorrect. The proposals will have a massive and ongoing impact! The ambulance service will become a permanent bureaucratic monopoly, with no possibility of outside involvement and/or competition unless sub contracted to the service and under their total control.

As ongoing fiscal restraint continues to apply to all levels of society it will become increasingly evident to parliament the ambulance service cannot continue on with their unrestrained expansion, yet this legislation will be used to prevent any logical changes required.

As an operator both working under the current Consent and having carefully studied the proposed changes to the legislation for private operators I must say I am unclear as to the need or benefits to be gained by such change. The Consent is robust and detailed; it has adequate penalties and is capable of being developed with mutual consent at any time. Most points raised in the proposed legislation exist in the Consent already. Why is there such a need to move it into legislation? Surely it is the task of parliamentarians to reverse this direction of cluttering legislation at all opportunities?

I believe the rational for change to the private ambulance sector is clear, but it is not in the way they have explained. It is to create a monopoly for the government ambulance service for life; to protect the ambulance structure for life; and to control the sub-sections of health transport for life. These changes are not good for Tasmania; they are not good for Tasmanians.
I have serious concerns regarding the ambulance bureaucracy’s level of understanding and empathy with their industry. They recently stated their own Patient Transport Service was providing transport to about 850 patients per month. They suggest the private sector is moving 1350 patient per annum, or just over 110 patients per month. Their figures confirm their position as the dominant entity in patient transport. I consistently exceed 1,000 patients a month and have done for some time! My company in the private sector is moving more patients than the government’s own patient transport service!

Not so long ago the budget for the Ambulance Tasmania patient transport service was approximately $4.2M. In other words they moved 10200 patients a year for $4.2M. If the proposed legislation critically damages the private ambulance sector by lowering caseload and opportunities, how much will it cost taxpayers to transport our 12000 plus patients per annum by Ambulance Tasmania? It is worth also pointing these figures raise serious doubts as to the logic behind initial and setup costs provided in this proposed legislation.